Re: post-prostatectomy PSA test

[Guest guest]

Ron,

In my opinion it is useful to assume recurrent disease and work from

there. As long as " undetectable PSA " is being chased you could remain on

ADT with a serious diminution of QoL.

I think it is far more important to achieve a constant / reducing PSADT

than undetectable PSA. However in order to reach this point an increase

in PSA from the artificially low ADT values is an inevitability.

Coming off ADT requires the androgen receptor (AR) to reaquaint itself

with normal levels of androgen. [Analogy: " Blinded by the Light " . After

being cooped up in a darkened room for months, a return to normal

daylight conditions can cause temporary blindness. This is due to

optical receptors unused to stimulus over reacting. Once the receptors

become used to light again, then sight returns.]

In practical terms, coming off ADT may mean PSA levels rising to fairly

high levels before they stabilise. This looks like a " dog's leg " or

" elbow " on a PSA vs Time graph. You just have to sit it out and see what

happens. This will require an understanding physician prepared to allow

you some leeway with your PSA " ceiling " and timely access to your

bloods.

Note: I am just the messenger. I don't guarantee anything. Managing your

disease within this framework is a new art / science.

Good luck,

Sam.

>

> I recently received my latest PSA results. The result was 0.1 ng/ml.

This result was higher than my normal <0.04 ng/ml which I've be getting

for the last three years. I checked with the lab and determined that my

doc had written a script for the " run of the mill " PSA test which was

coded as #5363. What he should have asked for was a " post-prostatectomy

PSA " test, coded as #14808.

>

> A small write-up for this test states:

>

> " 14808 This test is performed using the DPC IMMULITE 2000 method. For

post-prostatectomy patients. The lower limit of accurate quantification

for this assay is 0.01 ng/mL. PSA values less than 0.01 ng/mL cannot be

accurately measured and will be reported as less than 0.01 ng/mL.

Specimens with PSA levels below the lower limit of accurate

quantification should be considered as negative. In patients with a

negative result for post-prostatectomy PSA, serial monitoring of PSA

levels at regular intervals. along with physical examinations and other

tests, may help to detect recurrent prostate cancer. "

>

> Who Knew??

> Ron

>

[Guest guest]

RonK

>

> I recently received my latest PSA results. The result was 0.1

> ng/ml. This result was higher than my normal <0.04 ng/ml which

> I've be getting for the last three years. I checked with the

> lab and determined that my doc had written a script for the

> " run of the mill " PSA test which was coded as #5363. What he

> should have asked for was a " post-prostatectomy PSA " test,

> coded as #14808.

I presume the doctor was a general practitioner, not a urologist.

This is just the sort of thing that a GP might not know.

> A small write-up for this test states:

> " 14808 This test is performed using the DPC IMMULITE 2000

> method. For post-prostatectomy patients. The lower limit of

> accurate quantification for this assay is 0.01 ng/mL. PSA

> values less than 0.01 ng/mL cannot be accurately measured and

> will be reported as less than 0.01 ng/mL. Specimens with PSA

> levels below the lower limit of accurate quantification should

> be considered as negative. In patients with a negative result

> for post-prostatectomy PSA, serial monitoring of PSA levels at

> regular intervals. along with physical examinations and other

> tests, may help to detect recurrent prostate cancer. "

> Who Knew??

I didn't.

That was useful info.

Thanks.

Alan